Long-term admission to the intensive care unit: a cost-benefit analysis

Villar, S. Rodríguez; Yuste, Rafael

doi:10.1016/j.redar.2014.02.008

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Data on the desensitization procedure (indication, antibiotic involved, duration, completion, reactions) were recorded as previously described ( Rodríguez-Alarcón et al, 2022 ). Desensitization costs were calculated including antibiotic cost plus materials for preparation (bags, serums and syringes), human resources in pharmacy (pharmacy technician) and the cost of a 4-h process in an intensive care unit based on critical unit bed-day cost in Spain which is estimated to be 1,250€/day ( Rodríguez Villar and Barrientos Yuste, 2014 ).…”

Section: Methodsmentioning

confidence: 99%

A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

Rodríguez-Alarcón,

Sanz de Mena,

Alanti

et al. 2023

Front. Pharmacol.

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Introduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patients with PAL managed with antibiotic desensitization vs. those who received alternative non-beta-lactam antibiotic treatments.Methods: A retrospective 3:1 case-control study was performed between 2015–2022. Cases were adult PAL patients with infection who required antibiotic desensitization; controls were PAL patients with infection managed with an alternative antibiotic treatment. Cases and controls were adjusted for age, sex, infection source, and critical or non-critical medical services.Results: Fifty-six patients were included: 14 in the desensitization group, 42 in the control group. Compared to the control group, desensitized PAL patients had more comorbidities, with a higher Charlson index (7.4 vs. 5; p = 0.00) and more infections caused by multidrug-resistant (MDR) pathogens (57.1% vs. 28.6%; p = 0.05). Thirty-day mortality was 14.3% in the desensitized group, 28.6% in the control group (p = 0.24). Clinical cure occurred in 71.4% cases and 54.8% controls (p = 0.22). Four control patients selected for MDR strains after alternative treatment; selection of MDR strains did not occur in desensitized patients. Five controls had antibiotic-related adverse events, including Clostridioides difficile or nephrotoxicity. No antibiotic-related adverse events were found in the study group. In multivariate analysis, no differences between groups were observed for main variables.Conclusion: Desensitization was not associated with worse clinical outcomes, despite more severe patients in this group. Our study suggests that antibiotic desensitization may be a useful Antimicrobial Stewardship tool for the management of selected PAL patients.

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Section: Methodsmentioning

confidence: 99%

A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

Rodríguez-Alarcón,

Sanz de Mena,

Alanti

et al. 2023

Front. Pharmacol.

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“…These prolonged ICU hospitalizations have a major impact on ICU bed utilization 3,4 and on ICU resources consumption, 5 leading to a global economic burden with a high cost/patient ratio. 6,7 More importantly, this economic weight has raised concerns about the LSP prognosis and the relevance of allocating too many resources to a population with a potentially poor outcome. Results in this field have been conflicting.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies showed little to no survival difference between LSP and short-stay patients (SSP), with a reasonable functional outcome 8,9 for both populations, whereas other studies found increased in-ICU and in-hospital mortality, up to 61%, 10 with a poor quality of life for LSP. 7,11 These discrepancies may be explained by the heterogeneity of LOS defining LSP, ranging from more than 3 to 14 days in cardiac and surgical ICU, to more than 21 or 30 days in medical ICU. Data on the latter are scarce and while most studies focused on the economic cost of LSP, very few described the epidemiology of this specific population from admission to ICU discharge.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Predictors of Long-Stays in Medical ICU: A Retrospective Cohort Study

Hermann

Hauw‐Berlemont

Augy

et al. 2020

J Intensive Care Med

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Introduction: Prolonged stays in ICU have been associated with overconsumption of resources but little is known about their epidemiology. We aimed to identify predictors and prognostic factors of extended stays, studying a long-stay population. Methods: We present a retrospective cohort study between July 2000 and December 2013 comparing patients hospitalized in a medical ICU for ≥30 days (long-stay patients-LSP) with patients hospitalized for <30 days (short-stay patients-SSP). Admission characteristics were collected from the local database for every patient and evolution during the ICU stay was retrieved from LSP files. Results: Among 8906 patients hospitalized in the ICU, 417 (4.7%) were LSP. At admission, male sex (adjusted odds-ratio (aOR) 1.4 [1.1; 1.7]), inpatient (aOR 2.0 [1.6; 2.4]) and in-ICU hospitalizations for respiratory (aOR 2.9 [1.6; 3.5]) or infectious diseases (aOR 1.6 [1.1; 2.5]) were all independently associated with a long stay in the ICU, while hospitalizations for metabolic (aOR 0.2 [0.1; 0.5]) or cardiovascular diseases (aOR 0.3 [0.2; 0.5]) were in favor of a short stay. In-ICU and in-hospital LSP mortality were 38.8% and 48.2%. Age (aOR 1.02 [1.00-1.04]), catecholamines (aOR 3.9 [1.9; 8.5]), renal replacement therapy (aOR 2.4 [1.3; 4.3]), primary disease-related complications (aOR 2.5 [1.4; 4.6]) and nosocomial infections (aOR 4.1 [1.8; 10.1]) were independently associated with mortality in LSP. Conclusion: LSP were highly comorbid patients mainly hospitalized for respiratory diseases. Their mortality was mostly related to nosocomial infections but the majority were discharged alive from the hospital.

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“…Of mechanically ventilated patients, 5 to 10% develop CCI, consuming 20 to 40% of the time resources of the ICU [6,9]. Half of all CCI patients require long-term care combined with a great risk of nursing home admission.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a multivariable risk score for prolonged length of stay in the surgical intensive care unit

et al. 2019

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BACKGROUND: Chronically critical illness is highly relevant in intensive care units, but the definitions in literature vary greatly. The timely detection of prolonged intensive care unit length of stay could support care planning for chronically critical ill patients. AIM: To develop and validate a risk score for predicting prolonged length of stay in the surgical intensive care unit.METHODS: This single centre cohort study formed part of a nursing-led project in one surgical intensive care unit. We examined the performance of seven predefined predictive factors of prolonged (>20 days) intensive care unit length of stay in adults on the seventh day of stay in intensive care to develop (n = 304) and validate (n = 101) a risk score. Candidate variables (Charlson Comorbidity Index, Simplified Acute Physiology Score II, minimum plasma albumin, need for anti-infective drugs, time of mechanical ventilation, main feeding method and score on the Sedation-Agitation Scale) were analysed using multiple logistical regression analysis. RESULTS: Our risk score assigned different points to the following conditions: Charlson Comorbidity Index >2, minimum albumin <20 g/l between days 1 and 7, mechanical ventilation >14 hr on day 7 and the need for parenteral nutrition on day 7. For a validation data set (n = 101), the area under the receiver operating characteristic curve was 0.89 (95% confidence interval 0.770.87). At a cut-off value of 100 points, the degree of sensitivity was 88%, the specificity 75%, the positive predictive value 53%, the negative predictive value 95%, and the model fit R 2 0.40. CONCLUSIONS: Our model allowed the timely detection of prolonged intensive care unit length of stay with four candidate predictive factors. The timely identification of patients with prolonged intensive care unit length of stay is possible and could influence the person-centred prevention of chronically critical illness and adequate resource allocation. (Trial registration no DRKS 00017073

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Long-term admission to the intensive care unit: a cost-benefit analysis

Cited by 4 publications

References 28 publications

A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

Epidemiology and Predictors of Long-Stays in Medical ICU: A Retrospective Cohort Study

Development and validation of a multivariable risk score for prolonged length of stay in the surgical intensive care unit

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